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Bundles: Driving Volume and Predictable Pricing

Learn about Cleveland Clinic's history of bundling, current initiatives, challenges, and future plans. Discover how bundled payment models are used to drive volume and provide predictable pricing in specialty medical care.

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Bundles: Driving Volume and Predictable Pricing

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  1. PackagesEpisodesBundlesOH MY! Deb Lauricia, Senior Director Strategic Initiatives, Revenue Cycle February 16, 2017

  2. Agenda • Who we are • History of bundling at Cleveland Clinic • Current initiatives • International arena • Challenges • Where we are headed

  3. FRANK E. BUNTS, MD GEORGE CRILE SR., MD WILLIAM E. LOWER, MD JOHN PHILLIPS, MD Since 1921A Unique Model of Care • Four doctors share a vision • Non-profit, physician-led group practice • Collaboration across disciplines • All physicians are salaried • Patient-centered mission

  4. Cleveland Clinic Today • 49,000 caregivers • 6.6 million total visits • 164,000 hospital admissions • 3,400 physicians & scientists • 1,888 residents & fellows

  5. 2016 Cleveland ClinicU.S.News & World Report • #1 in Cardiology & Heart Surgery; 22nd consecutive year • 9 specialties ranked in top 3 • Ranked in 14 specialties • Cleveland Clinic Children’s ranked in 9 pediatric specialties

  6. Bundling • Specialty Medical Care Program • Began 20 years ago as means to drive volume and provide predictable pricing • Includes both the professional and technical services for a single encounter • High end inpatient • Small provider networks and large payers

  7. Bundling • Program for Advanced Medical Care • Expanded to include additional procedures and chronic conditions • Broad based commercial contract offering • Local Employers • Limited outpatient

  8. Episodes • Transplants • Includes pro and tech • Multiple payment methodologies • Phases • Flat rates • Fee for service up to maximum reimbursement

  9. Episodes • Time Based • Fixed period of time • All related services • Pro, tech, ancillary, etc • Single rate, single authorization • Direct to Employer business

  10. Episodes • Clinical Based • Defined clinical pathway • Retrospective • Medicare BPCI • Cardiac Rehab • Comprehensive Joint Replacement CJR • Ohio Medicaid State Innovation Models

  11. Population Health • Patient Centered Medical Home (PCMH) • Medicare Accountable Care Organization (ACO) • Comprehensive Primary Care Plus (CPC+) • Package additional services into standard care • IE: Chonic care management, outreach, etc.

  12. International • DRG based bundles • Other services percent of charge • Self pay, Embassy, International Payers • Moving to clinical based

  13. Challenges • Patient Identification • Registration issues • Manual claims process • Partnering with vendor for automation • Payment reconciliation • Small volumes • 292 cases / $21.5M

  14. Future State • Clinical Guarantees • CPC+ Management • Expansion of clinical bundles to commercial business • Prospective • Specialty Bundles: TAVR • Employee Health Plan Pilots • Gain Sharing

  15. Take Aways • Find what you do well and start there • Map your clinical process • Prepare for data, a lot • Insource vs Outsource • Patient identification is critical • Build a strong front end, lock it down • Resource for a manual billing flow • Technology is advancing • Create a process to handle the outliers • Reconcile, reconcile, reconcile

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